Provider Demographics
NPI:1083351282
Name:JAVA, STEVELAINE (MS MFT)
Entity Type:Individual
Prefix:
First Name:STEVELAINE
Middle Name:
Last Name:JAVA
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1407
Mailing Address - Country:US
Mailing Address - Phone:760-398-9000
Mailing Address - Fax:
Practice Address - Street 1:1251 EAGLE RD
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-2754
Practice Address - Country:US
Practice Address - Phone:951-826-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TB0200X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275753691OtherCOACHELLA VALLEY UNIFIED SCHOOL DISTRICT
CA1386852416OtherRIVERSIDE UNIVERSITY HEALTH SYSTEM
CA1043785983OtherCITY OF COACHELLA CALIFORNIA